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UNDERGR TANK PROGRAM OFFICIAL IN CTION REPORT <br /> E - SAN JOAQUIN HEALTH DISTRIOW <br /> 1601 E. HAZELTON AVE. <br /> COdNTY'RAME STOCKTON, CA 95205 <br /> COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: C INSPECTION DATE: <br /> I9JOh <br /> SITE ADDRESS: / - CITY/STATE/ZIP <br /> "5- <br /> e GG/J IOs� ^ - <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER # PER# PER # <br /> a(/�/ EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> TARKcoNT <br /> OPERATIONAL TAN IN <br /> MAJOR MINOR - <br /> PERMIT TO OPERATE I2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 _ <br /> APPROVED CONSTRUCTION 5 6 _ <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 120 1 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4445 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 _ <br /> PING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 _ <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 Cft <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED^AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: / e F-�t- <br /> f <br /> MAJOR 57 MINOR 58 NO 59 '- e <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: INSP: /I �z RECEIVED BY: <br /> TITLE: CPHONE: BECK: <br /> HUT-3 ORIGINAL sig 0' <br />